Ms Breda Kerans:

In terms of the various tragedies that have occurred, a number of key issues were highlighted that come under the heading of communications. My perspective is that of a service user. When care is transferred, whether it is between clinicians in the same hospital between different units, if communication fails between service users and the clinician or between primary care and the hospital anywhere along the line it is a huge risk factor and there can potentially be catastrophic outcomes. In many cases the communications failure will not lead to any adverse outcome because one will, essentially, get away with it as things go along as normal. However, if at any level that communication fails in terms of a really important event, for example, in the case of the maternal death in Galway one of the issues was laboratory results not being communicated in a timely fashion. That was one element of the situation. Communications are an issue across the board as they are also implicated in adverse emotional outcomes for families in terms of information being communicated in an inappropriate manner, at an inappropriate time or by a person not trained to give the information. That was one issue that was highlighted.

The dependency on agency staffing or staff whose training level is not up to date in key areas such as neonatal resuscitation, came up as another issue. Agency staff are not necessarily familiar with the hospital setting they are in, which also plays a part. If one has come to work in a hospital for the first time and a major event happens one does not necessarily know who to ring, where the theatre is or other important bits of information. Training at all levels has been highlighted for NCHDs and midwifery training as well as key skills that need to be up to date in order to deliver safe health care.

The issue of rural units that do not have scanning and other facilities was raised. Dr. Lynch and Dr. Boylan already covered home births. In terms of the smaller units that currently operate, it is important to weigh up travel distances in terms of safety outcomes and babies born before they arrive at the hospital and the risk factors that exist, in particular given that we do not have a lot of anomaly scanning in those units we do not know who will be born at the side of the road. It is far worse to be born at the side of a road than to be born in a unit no matter how good the unit is. That must also be taken into account.

In terms of perinatal mental health units, Dr. Boylan mentioned that we do not have any mother and baby units. He is correct. Women are separated from babies. In some of the regional units where there are psychiatric units on a hospital site it is a little less traumatic for the family because at least the mother and baby are on the same site and they can visit each other, but where that is not the case, which in effect is in most hospitals, it means there is a distance between the mother and the baby which is incredible in this day and age. One must take into account the psychological impact on the mother and infant development in the long term. Bonding between the mother and baby is compromised in such situations. That is certainly not best practice internationally.

Dr. Lynch mentioned that there is a big issue around mental health administrative zones and maternity zones. They do not measure up at all. The difficulty between matching up the zone for the maternity unit and the women attending there and the community mental health zone and the communication between them is something that was highlighted on the perinatal mental health group in Galway as being another risk factor. I think everything else has been covered. I do not wish to hold up the meeting.